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First Name
Last Name
Age
Birthday
Marital Status
Single
Married
Divorced
Living Together
Other (please explain)
Do you have children? If no, leave blank. If yes, what are their names and ages?
What is your faith background?
Catholic
Muslim
Christian
Jewish
Hindu
No religion
Others (please specify)
Are you currently under the care of a counselor, therapist, or psychologist?
Yes
No
Address
City
State
Zip
Phone
Email
Where do you work?
Title or Position?
Website
Business Name
What are some of your hobbies?
How would you describe your personality?
Check any of the areas below that you feel you could use some coaching:
Time management
Improving relationship(s)
Money management
Eliminating a bad habit
Health (exercise, diet, rest)
Discovery of purpose and passion
Needing to make a decision
Needing to make a transition
Best career options
How to get better at focusing
Living according to your values
Goal setting
Career change
Other (please explain)
What are you desiring to gain or understand through the 320 Coaching process?
How are you currently moving yourself forward? (Pick 2 and explain)
Intellectual
Emotional
Physical
Marital
Parental
Social
Vocational
Avocational (Hobby)
Financial
Explain
In what area are you struggling the most in your leadership?
Intellectual
Emotional
Physical
Marital
Parental
Social
Vocational
Avocational (Hobby)
Financial
Explain
What does a coaching relationship look like for you?
What are two things in life that you’re most proud of accomplishing?
What do you wish to change or reshape in your life?
Use the drop down list to rank yourself on the following statements.
I lead myself well
Not true
Sometimes true
True
Very true
I am able to focus most of the time
Not true
Sometimes true
True
Very true
I live according to my values
Not true
Sometimes true
True
Very true
I am clear on my unique purpose
Not true
Sometimes true
True
Very true
I have a vision for my life
Not true
Sometimes true
True
Very true
I set goals regularly for myself
Not true
Sometimes true
True
Very true
Have you had any previous experience with a leadership coach? (please explain)
How did you hear about 320 Coach?
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